Sunday, May 18, 2014


First off:  This is informational only. Please, please, PLEASE, use this to talk to YOUR DOCTOR. Don't treat yourself. Don't stop medications unilaterally. Use this to add to your knowledge base as you talk to your Doc.This information is not meant to be medical advice.

Stress incontinence. This is the run, jump, cough, laugh, sneeze  incontinence.

Urge incontinence-is the "got to go right now or I'm going to have an accident" incontinence. Or the "Key in the doorknob" incontinence.

Mixed incontinence-it's a combination of urge and stress incontinence. Your bladder is very full and you've got to go, NOW, and then you cough and then leak.

Overflow incontinence
-"Oh my, my bladder is so full that I had better get to the bathroom right now or.... oh bummer!"---type of incontinence. Often there is frequent or constant dribbling or inability to empty the bladder, and the stream is weak. This can be caused by bladder injury, a blocked urethra, MS, diabetes or prostate gland problems(in men).

Functional incontinence occurs because people are mentally or physically unable to make it to the toilet. Think, nursing home patient with dementia, or immobilization from physical illness.

When you have incontinence, you and your doctor need to look at your diet, overall health, and your medications.  

For example, coffee, tea, soda and alcohol can increase incontinence. (I know, right?! Always the good stuff) They are all mild diuretics and/or stimulants of the bladder.
Drinking large volumes of fluids, quickly, increases the amount of urine in the bladder.

Diuretics, also known as "water pills" can increase your urine output and make it virtually impossible to get to the bathroom in time, especially if you already have difficulty moving quickly.

Muscle relaxants, blood pressure and heart medicines can sometimes affect the muscles, or the amount of urine your body makes. (Don't stop them. Talk to your Doc)

  • Uncontrolled Diabetes increases the amount of urine the kidneys make.
  • Obesity increases the pressure on the pelvic floor and increases leakage. 
  • Constipation increases incontinence by interfering with emptying of the bladder, or by pushing on and irritating the sacral nerves. 
  •  Pregnancy hormones and the stress of vaginal delivery affect supportive tissues and cause the pelvic floor to prolapse. 
  • Hysterectomy can increase the likelihood of incontinence. 
  • Bladder infections can cause incontinence. 
  • Kidney stones, bladder stones and bladder tumors can cause incontinence.
  • Aging can decrease the bladder's storage capacity
  • Menopause decreases estrogen which causes the tissues around the urethra to shrink back/atrophy.
  • Prostatitis -an infection in the prostate in men, sometimes causes incontinence. 
  • Benign prostatic hypertrophy or Prostate cancer, both, can cause the bladder to get blocked off and also the treatment of that can cause leakage. 
  • Neurologic diseases like Stroke, Multiple Sclerosis, Dementia, Parkinson's, Spinal cord tumors, Spinal cord damage, Brain tumors, all can affect bladder function

SO...What the heck do I tell my doctor? Isn't it normal to have urinary leaking? I mean, Look at that list! Seriously? What DOESN'T cause incontinence?

1.) Keep a Urinary and Fluid Intake Diary. Yes, I know that sounds weird and OCD, but believe it or not, I've had people drink 3 gallons of water a day and wonder why they had urinary frequency. 

2.) Bring a list of medications to every single appointment. 

3.) Write down your specific symptoms.

4.) Write down recent life changes, for example, longer commute to work? Increased stress at home? New medications? New herbal supplements or vitamins?

Testing you might have: 
1. Urinalysis and culture to check for abnormal blood cells, infections, etc.

2. Blood tests to check for diabetes, thyroid, etc.

3. Pelvic Ultrasound to check for abnormalities in the pelvic organs.

4. Post Void Residual or Bladder Scan. Here, a gyne or urologist or urogynecologist, has you urinate, then checks how much urine is left in your bladder with a special scan or with a catheter.

5. Urodynamic Scanning-usually done by the urologist or urogynecologist. It measures how much
 pressure is in your bladder at rest and as it fills. This can help with whether the sphincter is healthy
 or the muscles of the bladder are over or under active.

6. Cystoscopy-a fiberoptic scope is inserted through the urethra into the bladder to look around for
  tumors, stones, blockages in the lower urinary tract.

Treatment:  It Depends on the TYPE of incontinence and your other medical conditions.

Timed Voiding-going every 1-2 hours on schedule

Bladder Training-delaying urination by increasing lengths of time after you get the urge to go.

Double voiding -go, then wait and go again, to help you completely empty your bladder.

Fluid/Diet Management-lose weight, limit alcohol, caffeine, soda, acidic foods and fluid volume.

Physical Therapy- Pelvic floor exercises-done by a specially trained physical therapist to teach you the correct muscles to tighten and relax. They also use special biofeedback devices and gentle TENS units (electrical stimulation). You learn how to do the exercises at home and it takes months.

Anticholinergic medications-used for overactive bladder/urge incontinence. Lots of side effects but often very helpful

Topical estrogen-creams, rings, patch-improves the thinning out of the tissues and improves tone. Bonus:  It may Also help with pain with intercourse seen post menopausally. Again, side effects/adverse effects like blood clots. stroke, uterine lining cancer, etc. but very helpful in the right circumstances.

Duloxetine-an antidepressant sometimes used for stress incontinence

Imipramine-an old fashioned tricyclic antidepressant sometimes used for mixed incontinence but again-tons of side effects. Cardiac arrhythmias, dry mouth/eyes, feeling faint/lightheaded,
     constipation.  I have seen it used, mostly by urogynecologists.

Non-Surgical Treatments-
Pessary- is a rubbery knobby ring like device that is placed into the vagina to press on the urethra  to prevent leakage. It has to be cleaned regularly, and often, vaginal estrogen is used with it to  prevent irritation of the vaginal mucous membranes.

Photo credit:

Collagen or other bulking injections-again done by urogynecologist, around the urethra, to bulk up the tissues and keep the urethra closed and leakage reduced. Generally has to be repeated, however.

Nerve stimulators- I've seen one, once. It's like a pacemaker for your bladder. It is attached to the sacral nerves which go to the bladder. It helps prevent overactive bladder.

Surgical Treatments:
 Sling procedure-a bit of synthetic tissue/mesh or your own body's tissue is used to make a sling to pull up the bladder neck and urethra if it's fallen down/prolapsed. This really helps most with
stress incontinence.

There are others, but a urogynecolgist or urologist are the best judges of which of these will work

Skin Care: 
Pads/Diapers/Undergarments-there are all different types out there now. Most important, realize that  menstrual pads are not designed to absorb urine. They may be cheaper, but they are not designed to absorb urine.
 There are smaller volume pads, larger volume pads, night time garments, etc. MOST important is to change them when they get wet to protect your skin. 
Use zinc oxide ointments/creams (Desitin, Boudreaux's Butt Paste, etc) to protect your delicate skin and prevent sores and ulcers from the urine. Keep your skin clean but be very gentle.

Don't get dehydrated to prevent urine leakage. It's tempting to just stop drinking fluids, so you don't leak.

Especially if you are on blood pressure medications, or are older, this is a bad idea and can cause dehydration and kidney failure. Talk to your doctor about how much fluid YOU should be taking in a day, as it's different depending on your medical conditions. 

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